Cutaneous Adverse Drug Reactions in Hospitalized HIV/AIDS Patients Yusuf Wibisono, Indropo Agusni, Afif Nurul Hidayati, Rahmadewi, Maylita Sari, Astindari, Septiana, Dwi Murtiastutik Department of Dermatology and Venereology, Faculty of Medicine, Universitas Airlangga/Dr. Soetomo General Academic Hospital, Universitas Airlangga Teaching Hospital, Surabaya, Indonesia ABSTRACT Background: Cutaneous adverse drug reaction (CADR) is the most common manifestation of drug hypersensitivity in human immunodeficiency virus (HIV), which presented as maculopapular rash. The incidence of CADR is found to be more common in untreated HIV patients, and the frequency is higher in severe immunodeficiency status. Early diagnosis and appropriate treatment give better outcomes. Purpose: To evaluate the incidence and management of CADR in HIV and acquired immune deficiency syndrome (AIDS) patients. Methods: A retrospective descriptive study of HIV/AIDS patients with CADR who were hospitalized at Intermediate Care and Infectious Disease Centre Dr. Soetomo General Academic Hospital. Result: There were more CADR cases in 2017, accounted 2.35% of the total Intermediate Care and Infectious Disease Centre RSUD Dr. Soetomo General Academic Teaching Hospital ward patients. There were more male patients (62.5%), with the most commonly found at the age of 25-44 years (64.3%), and which mostly (89.3%) originated from Surabaya. The most common diagnosis was morbiliform eruption (60.7%), main complaint was red spots all over the body (45%), all of which are obscure erythematous macules. The most common causes were Duviral + Neviral antiretroviral (46%) and the most common treatment was dexamethasone injection. Conclusion: The incidence of CADR increased in 2017. The most frequent manifestation was morbilliform eruption due to Duviral+Neviral as the first line ARV treatment. Skin management varies widely in form of topical, oral, and intravenous injection drugs, mostly using steroid class, dexamethasone intravenous injection in particular. Keywords: CADR, HIV, AIDS, antiretroviral, morbiliform eruption, SJS. Correspondence: Afif Nurul Hidayati, Department of Dermatology and Venereology, Faculty of Medicine, Universitas Airlangga/Dr. Soetomo General Academic Hospital/Universitas Airlangga Teaching Hospital, Surabaya, Indonesia. Email: afif_nurulhidayati@fk.unair.ac.id. BACKGROUND Human Immunodeficiency Virus (HIV) is the cause of acquired immunodeficiency syndrome (AIDS) by weakening the human immune system. 1–3 Adverse drug reactions (ADR) are a major health problem in outpatient and hospitalized patients. They can be classified as predictable (Type A) and unpredictable reactions (Type B). Type B reactions can be classified as drug intolerance, drug idiosyncrasy, drug allergies, and pseudoallergic reactions. Both types of reactions can be affected by genetic predisposition. Drug included hypersensitivity classification system according to The Gell and Coombs includes Ig-E mediated (Type 1), cytotoxic (Type 2), immune complex (Type 3), and delayed cellular mediated (Type 4). Type 4 hypersensitivity reactions are responsible for delayed cutaneous eruptions such as maculapapular exanthema due to antibiotics and acute generalized exanthematous pustulosis. 4 HIV patients exhibit complex immunological changes. Multiple drugs that usually prescribed for prevention or treatment of opportunistic infections and antiretroviral therapy (ARV) cause higher risk of drug hypersensitivity reactions in these patients. Cutaneus adverse drug reaction (CADR) is the most common manifestation of drug hypersensitivity in HIV patients which presented as maculopapular rash with or without systemic symptoms and internal organ involvement. The onset is usually delayed and severe cutaneus drug hypersensitivity reactions such as erythema multiforme, Steven Johnson Syndrome (SJS), and Toxic Epidermal Necrolysis (TEN) are more frequent in HIV patients. 4 The incidence of CADR is more frequent in untreated HIV patients and patients with advanced immunodeficiency status. 5 To establish the correct diagnosis and treatment of HIV/AIDS patients, early and appropriate treatment provide a better progress or shorter course of disease. Education is also a vital aspect of managing CADR. METHODS A retrospective study of HIV/AIDS patients with CADR, carried out using secondary data from patient medical record who were hospitalized in Intermediate Care and Infectious Disease Centre RSUD Dr. Soetomo General Academic Hospital Surabaya during January 4 th 2016 to December 30 th 2017, which were collected from December 2017 until February 2018. 96